Osteoarthritis

Topic Overview

What is osteoarthritis?

Osteoarthritis is a painful problem with the joints.
Healthy joints help your body move, bend, and twist. Knees glide up
and down stairs without creaking or crunching. Hips move you along on a walk
without a complaint. But when you have arthritis, such
simple, everyday movements can hurt. Using the stairs can
be painful. Walking a few steps, opening a door, and even combing your hair can
be hard.

Arthritis
is mainly a disease of the
spine, hip, hand, knee, and foot. But it can happen in other joints too. A
joint is where two bones connect. And you have them all over your body.

Arthritis is most common in older people. Even
though you can't cure arthritis, there are many
treatments that can help with your pain and make it easier for you to move. And
you can do things to keep the damage from getting worse.

What causes osteoarthritis?

The simplest way to
describe arthritis is that it's wear and tear on the
cartilage of your joints. This cushioning tissue is firm, thick, and slippery.
It covers and
protects the ends of bones where they meet to form a joint.

With
arthritis, there are changes in the cartilage that cause it to break down. When
it breaks down, the bones rub together and cause damage and pain. Experts
don't know why this breakdown in cartilage happens. But
aging, joint injury, being overweight, and genetics may be a part of the
reason.

What are the symptoms?

Pain. Your joints may
ache, or the pain may feel burning or sharp.

Stiffness. Getting up in the morning can be hard. Your joints may feel stiff and creaky
for a short time, until you get moving.

Muscle weakness. The muscles around
the joint may get weaker. This happens a lot with arthritis in the
knee.

Deformed joints. Joints can start to
look like they are the wrong shape, especially as arthritis gets
worse.

Reduced range of motion and loss of use of the joint. As your arthritis gets worse, you may not be able
to fully bend, flex, or extend your joints. Or you may not be able to use them
at all.

Cracking and creaking. Your
joints may make crunching, creaking sounds.

How is osteoarthritis diagnosed?

Your doctor will check that your
pain is not caused by another problem.
He or she will ask questions about your symptoms, such as:

Is the pain burning, aching, or sharp?

Are your
joints stiff in the morning? If yes, how long does the stiffness
last?

Do you have any joint swelling?

If your joints are tender and swollen and the muscles are weak, this
will also help your doctor confirm whether you have arthritis. You may also
have X-rays to check your joints for damage.
Your doctor may want to do blood tests or other tests to see if there are other
causes for your pain.

How is it treated?

There are many treatments for arthritis, but what
works for someone else may not help you. Work with your doctor to find what is
best for you. Often a mix of things helps the most.

Your treatment may
include:

Using pain medicine.
If your pain is mild, over-the-counter pain medicines such as acetaminophen (for example,
Tylenol) and
nonsteroidal anti-inflammatory drugs (NSAIDs) may help. Commonly used NSAIDs include ibuprofen (such as Advil and Motrin) and naproxen (such as Aleve). But if these don't get rid of
your pain, you may need a stronger prescription medicine. Having shots of
medicine in the joint also helps some people.

Using heat or ice on the painful joint. Heat may help you loosen up before an activity. Ice is a good
pain reliever after activity or exercise. Your doctor may give you gels or
creams that you can rub on the joint to make it stop hurting.

Losing weight, if you're overweight. Losing weight may be one
of the best things you can do for your arthritis. It helps take some of the
stress off of your joints.

Exercising to strengthen your muscles. Having stronger thigh muscles, for example, can help
reduce stress on your knees. Swimming, biking, and walking are good activities.
But make sure you talk to your doctor about what kind of activity is best for
you. You may also get help from a physical therapist.

Having surgery. If the pain in your hip or knee does not get better with treatment, you may decide to have surgery to replace the joint.

There are also some things you can do at home to help relieve your symptoms. For example, there are devices and tools that can take the stress and weight off of your joints and make it easier for you to hold objects, open and close things, and walk. Doorknob covers, tape, braces, splints, and canes may help.

You might also try changing activities or the way you do things to reduce the stress on the joint
that hurts and
allow you to move better. For example, walk instead of jog. Or use a sewing machine to make a quilt instead of making it by hand.

Cause

Osteoarthritis occurs
when changes in
cartilage cause it to
break down and wear away.
When cartilage breaks down, the bones rub together and cause damage
and pain. Experts don't know why this happens. But things like aging, joint
injury, being overweight, and genetics may increase your risk.

Symptoms

Pain. Your joints may
ache, or the pain may feel burning or sharp. For some people, the pain may come
and go. Constant pain or pain while you sleep may be a sign that your arthritis
is getting worse.

Stiffness. When you have arthritis, getting up in the morning
can be hard. Your joints may feel stiff and creaky for a short time, until you
get moving. You may also get stiff from sitting.

Muscle weakness.
The muscles around the joint may get weaker. This happens a lot with arthritis
in the knee.

Swelling. Osteoarthritis does not usually cause much swelling but may cause a little, especially in the knees.

Deformed joints. Joints can start to look like they are the
wrong shape, especially as arthritis gets worse.

Reduced range of motion and loss of use of the joint. As your
arthritis gets worse, you may not be able to fully bend, flex, or extend your joints. Or you may not be able to use them at all.

Cracking and creaking. Your joints may make crunching,
creaking sounds. This creaking may also occur in a normal joint. But in most cases, it doesn't hurt and doesn't mean that there is anything wrong with the joint.

Sleep problems. The pain and stiffness of arthritis can disrupt sleep. And sleep problems may make it harder to cope with pain.

Arthritis of the spine can also narrow the openings
that make space for the spinal cord and for the nerves that branch off the
spinal cord (spinal nerves). This is called
spinal stenosis. It can lead to pressure on the spinal
cord or spinal nerves. This pressure can cause pain, weakness, or
numbness.

Some medical
conditions can cause symptoms similar to osteoarthritis, such as joint injuries and other forms of arthritis.

One Man's Story:

Steve, 55

"I thought the stiffness and pain in my
hip was just from the stress I was putting on my muscles. But when I changed my
exercise routine or stopped working out, the pain was still there ... The
pain would come and go. It wasn't a sharp pain, but a kind of ache that would
keep me awake a lot. I could never stay in one position for very long."—Steve

What Happens

Osteoarthritis occurs when the cartilage that cushions your joints breaks down and
wears away. When this happens, the bones rub together and cause damage and
pain. In most cases, it takes years for cartilage to break down.

It's hard to know how fast arthritis may
progress.
You may not have any symptoms for years, until the bones
and tissues become damaged. Or symptoms may come and go, stay the
same, or get worse over time.

Arthritis can
cause problems in any joint in the body. But in most cases, you'll have
symptoms in only one or two joints or
groups of joints. Arthritis may cause problems in your
hands,
hips,
knees, or
feet, and sometimes in your
spine. At first, you may only
feel pain when you're active. As the disease
gets worse, you may also feel pain when you're
at rest.

If you have arthritis in your
fingers, the joints at the tip or middle part of your fingers may get bigger
and form bumps. These are known as
Heberden's and Bouchard's nodes.

Even though there is no cure
for arthritis, most people can manage their symptoms with medicine
and lifestyle changes. But in a few people, arthritis or complications of arthritis may
get so bad that they decide to have surgery to replace the worn joint or to fuse the bones together so
that the joint won't bend.

What Increases Your Risk

Things that can
increase your risk for
osteoarthritis are called risk factors. Some risk
factors, such as your age or family history, can't be changed or
prevented.

You may be able to reduce other risk factors by making lifestyle changes or taking medicine.

Risk factors you may be able to change or prevent

Being overweight. Extra weight puts added stress on your joints and can change
the normal shape of the joint.

Joint injury. A
single major injury to a joint or several minor injuries can cause cartilage
damage over time. Activities that put repeated stress on a joint include
squatting, kneeling, or heavy lifting common to some sports and
jobs.

Lack of exercise, which can cause your muscles and joints to get weak and stiff.

Risk factors you can't change

Getting older. Age is not a direct cause of arthritis, but as you get older
you're more likely to have symptoms. Still, not all older adults will have
joint pain.

Loose or odd-shaped joints. Knees that bend outward (bowleg) or knees that bend
toward each other (knock knees), for example, can cause an imbalance in the
joints, because the
cartilage wears down at an uneven
rate.

Exams and Tests

In most cases, your doctor can
tell you if you have
osteoarthritis and recommend treatment based on your
symptoms and by doing a
physical exam. Your doctor may also do some
other tests to be sure that the diagnosis is correct or to rule out other
conditions that have similar symptoms.

These tests may
include:

A joint fluid
study. A sample of the fluid that
cushions the joint is removed and sent to the lab to look for the cause of
joint pain and swelling.

X-rays. Pictures of the bones in a joint, such as the
hip
or knee, are taken to look for cartilage
damage.

Other tests may include a
urine test and one or more blood
tests, such as:

Some people with arthritis also feel down or depressed. They may describe this as feeling "depressed," "unhappy," "short-tempered," "blue," or "down in the dumps." If you feel like this most of the time, tell your doctor. Treating these symptoms may help you feel better and make it easier for you to do your daily tasks.

Treatment if arthritis gets worse

If the pain and stiffness from arthritis don't get
better or they get worse, your doctor may
recommend:

If your pain is very bad, you may decide to have
surgery to replace the joint. Or you may decide to have some other kind of surgery that
can help keep your joints moving well and prevent your arthritis from getting
worse.

Prevention

You can take steps to help prevent
osteoarthritis. If you already have arthritis, these
same steps may keep it from getting worse.

Stay at a healthy weight or lose weight if you need to. Extra weight puts a
lot of stress on the large, weight-bearing joints such as the knees,
the hips, and the balls of the feet. Experts estimate that every
1 lb (0.5 kg) of body weight
adds about
4 lb (1.8 kg) of stress
to the knee.footnote 1 This
means that if you lost just
5 lb (2.3 kg), you
could take
20 lb (9.1 kg) of stress off
your knees.

Be active. A lack of exercise can cause your muscles and joints to
become weak. But light to moderate exercise can help keep
your muscles strong and reduce joint pain and stiffness. For example, if your quadriceps (the muscles
in the front of your thigh) are weak, you may be more likely to get arthritis
of the knee.

Protect your joints. Try not to do tasks that cause pain or swelling in joints. And try to use the largest joints or
strongest muscles to do things. A single major injury to a joint or several
minor injuries can damage cartilage over time.

Home Treatment

When you have
osteoarthritis, you may find it hard to do your daily
tasks. Your joints may ache or feel stiff, and they may hurt when you
move. You can do some things at
home to feel better.

Lifestyle changes

Rest. If your
joints hurt a lot or are swollen, take a break. But try not to let too much
time pass before you get moving again. A lack of activity can cause your
muscles and joints to become weak. Getting enough sleep can help your mood and help you cope with pain. If you are having trouble sleeping, talk to your doctor.

Stay at a healthy weight. Being overweight puts extra stress on your
joints. But losing weight can help. It can decrease the symptoms of osteoarthritis and allow you to be more active.footnote 2

Exercise.
Some
people may be reluctant to exercise when they have arthritis, but it can help
reduce pain and improve balance. Try exercises that don't put a lot of stress on your joints, such as
swimming, biking, walking, water exercises, and lifting light weights. And consider taking an exercise class designed for people who have arthritis. Many fitness clubs, community centers, and senior centers offer these classes. Be sure to talk to your doctor or physical
therapist about what kind of activity is best for you.

Use devices

Use assistive devices and orthotics. There are devices and tools that can take
the stress and weight off your joints and make it easier for you to hold
objects, open and close things, and walk. For example, doorknob
covers, tape, braces, splints, and
canes may help.

Change how you do things

Protect your joints. There are some things that you can do to protect your joints.
For example:

Try not to do tasks that cause pain or swelling in joints.

Use the largest joints or strongest
muscles to do things. For example, when you lift a heavy object off the floor,
use your hip and knee muscles, not your back. Or when you carry a bag of
groceries, use the palm of your hand or your forearm instead of grasping it
with your fingers.

Change activities. If your joints hurt when you do an
activity, try other ways of doing it that don't cause pain. For example, walk
instead of jog. Or use a sewing machine to make a quilt instead of making it by hand.

Modify your home and work area. If you have a hard time moving around or if you get tired
easily, try making some changes in your home and work areas. For example,
use a reacher to pick up things off the floor. Or for tasks that you would
normally do standing up, use a tall stool instead so you can sit
down.

Maintain good posture. Poor
posture puts stress on your back and neck. The key to good posture is to keep
the right amount of curve in your lower back. Too much curve (swayback) or too
little (flat back) can cause problems. Having good posture can help reduce
pain.

Wear comfortable and supportive shoes. If you have arthritis in your back, hips, knees, or feet, you may be able to reduce the stress on your joints by wearing the right shoes or by adding insoles to your shoes. Talk to your doctor or physical therapist about the footwear that would be best for you.

Use medicine and heat or cold

Use over-the-counter pain medicines, such as
acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen. Be safe with medicines. Read and follow all instructions on the label.

"Gardening books and magazines always have wonderful ideas and innovations that you can use. For instance, I've cut off sections of the rubber insulation that is used to cover water pipes and slipped them over any of the garden tools that I'm going to use, because it gives me a little more cushion and a little extra width for my tools."—Bev

Coping and support

Living with arthritis can be stressful. At times you
may feel overwhelmed, tired, and angry. And you may worry about what your life
may be like as your condition gets worse. These feelings are normal. But there
are a lot of ways to cope with arthritis. For example, ask for help when you
need it, keep a positive attitude, and join a support group.

If
you are caring for someone who has arthritis, be sure to take time to care for
yourself and find ways to manage stress. Being a caregiver isn't easy. But it
can be rewarding, especially when you know that your care makes a positive
difference in someone's life.

Medicine that you put on your skin (topical)
may relieve pain for a short time.footnote 3 These include topical NSAIDs,
capsaicin, and pain-relieving creams.

What to think about

Before you take medicine

Here are a few things to think about:

Medicine doesn't cure arthritis
or slow the time it takes for
cartilage to break down. But it can help reduce pain
and stiffness, which can make it easier for you to move.

Medicine should be used along with other
treatments, such as exercise and physical therapy, to help keep your joints
working and moving well.

If you have
certain health problems, you may not be able to take some kinds of pain
medicine. Be sure to tell your doctor if you have a history of bleeding in your
stomach or another part of your digestive tract. And tell your doctor if you
have a stomach
ulcer, kidney problems, or
heart failure, or if you take a blood-thinner
medicine.

Effects of medicines

Medicines that work for some people don't work for others. Be
sure to let your doctor know if the medicine you're taking doesn't help. You
may need to try several kinds of medicines to find one that works for
you.

Be safe with medicines. Read and follow all instructions on the label.

Here are a few things to think
about:

The medicine you take may cause
side effects. Your doctor may suggest that you first try
acetaminophen, because it has
fewer side effects than any
other pain medicine used for
arthritis.

Most studies suggest that
nonsteroidal anti-inflammatory drugs (NSAIDs) work
better than acetaminophen for arthritis. But for some people, acetaminophen may
work as well as NSAIDs for mild to moderate joint pain. And studies show that
acetaminophen is better than no treatment.footnote 4

If you can't take NSAIDs,
and if other treatments haven't worked, your doctor may prescribe
opioids. When taken as prescribed, they can be a safe
and effective way to relieve pain.

Because you'll likely take medicine for a long
time, you'll need to see your doctor for regular checkups to look for any side
effects that may develop from long-term use. He or she may prescribe medicine
that can help prevent stomach ulcers, which may develop when you take pain
medicine every day.

Surgery

In most cases, people can manage their
osteoarthritis symptoms with medicine and lifestyle
changes. But surgery may be an option
if:

You have very bad pain.

You have lost a lot
of
cartilage.

You have tried medicine and
other treatments, but they haven't helped.

Your overall health is
good.

One Man's Story:

Steve, 55

"I wasn't sure about having surgery
since I was so young. I had heard that an artificial hip could give out in 10
to 20 years ... But when the medicine I was taking stopped working, I figured
I had gone as far as I could go with this, and decided to go ahead with the
surgery ... It's a strange feeling to be able to walk without a limp and to
walk up and down stairs without grabbing on to the railing."—Steve

Surgery choices

Types of surgery for arthritis
include:

Arthrodesis. This joins (fuses)
two bones in a damaged joint so that the joint
won't bend. Doctors may use it to treat
arthritis of the spine, ankles, hands, and feet. In rare
cases, it's used to treat the knees and hips.

Arthroscopy. This may be used to smooth a rough joint surface or remove loose cartilage or bone fragments. In some people it may help relieve pain for a short time and allow the joint to move better.

Hip resurfacing surgery. This is most often done in younger, more active people
who have pain and disability caused by a badly
damaged hip.

Joint replacement. This is done when other treatments haven't worked
and damage to the joint can be seen on X-rays.
It involves surgery to replace the ends of bones in a damaged joint.
The surgery creates new joint surfaces. The joints that are replaced most often are the hip, knee, and shoulder. But other joints such as the elbow and the ankle can also be replaced.

Osteotomy. This is done to correct certain
defects in the hip and knee. In most cases, it's done in active people younger
than 60 who want to delay surgery to replace a hip
or knee.

Small joint surgery. Surgery is more common on the larger joints, such as the hip and the knee. But if pain in the small joints of the hands or feet is so bad that the person can't use those joints, surgery may help.

A newer procedure for arthritis of the knee
uses a small cup shaped like a "C." It's placed in the joint space of the inner
knee and acts as a cushion for the joint. It may help delay surgery to replace
the knee.

What to think about

Before deciding to have surgery

If you're in poor health or have certain health problems, you may not be able to have surgery. Your doctor can help you decide if surgery is right for you.

Here are some things to think about if you're
thinking about surgery:

After surgery, most people are
able to go back to doing their daily tasks and sports with less pain.

You will need several months of physical therapy to
get the best use of your joint.

Replacement
joints typically last 10 to 20 years. You may need
another surgery if the new joint
wears out.

If you have already lost a lot of your strength, flexibility, balance, endurance, and ability to be active before you have surgery, then after the surgery you might have a harder time returning to your normal activities.

If you decide to have surgery

In the days or weeks before your surgery, talk to your doctor about what you need to do to get ready for your return home. For example, you may need to arrange for someone to drive you home and to help
you after your surgery. Or you may need to make changes to your home, such as removing small rugs, to help you move around.

Other Treatment

Many people use some form of complementary medicine to treat certain health problems, including osteoarthritis. These treatments are often used along with standard care to help relieve their
arthritis symptoms.

Some of these treatments may help you move more easily and deal with the stress and pain of arthritis. But in some cases, not much is known about how safe they are or how well they may work.

Be sure to tell your doctor if you're using a complementary therapy or if you're thinking about trying one. He or she can discuss the possible benefits and potential side effects of these treatments and whether any of these treatments may interfere with your standard care. For example, some diet supplements and herbal medicines may cause problems if you take them with another medicine.

Other treatments to
consider

Taping uses tape that sticks to the knee to help keep the kneecap in
place and relieve pain. You can do taping at home. But
first have your doctor or physical therapist show you the right way to put it
on.

Braces can
help shift weight off the part of your knee
that hurts. It's not clear how well
these work, but there isn't a lot of risk in
trying them.

"After I have a massage and acupuncture, I feel
like a new person. I encourage people to find out what treatments others have
tried and what things have worked for them. I'm a believer in other people's
ideas. Obviously, what works for one person may not work for another, but
unless you try it, you'll never know if it'll help."—Bev

What to think about

There are many
treatments for arthritis, but what works for someone else may not work for you.
You may need to try several different treatments to find what works for
you.

Experts are testing new
medicines and methods that they hope will one day help prevent, reduce, or
repair cartilage damage. For example, they're looking at cartilage transplants
and the use of stem cells to grow new cartilage. So far, therapies to repair
cartilage have only been studied in younger people with small, well-defined
holes in their knee cartilage. This isn't a common problem for most older
adults who have arthritis of the knee.

Other Works Consulted

American Academy of Orthopaedic Surgeons (2013). Summary of recommendations. Treatment of Osteoarthritis of the Knee, 2nd ed. Available online: http://www.aaos.org/research/guidelines/guidelineoaknee.asp.

Hochberg MC, et al. (2012). American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care & Research, 64(4): 465–474.

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